Provider Demographics
NPI:1912600297
Name:ROSENTHAL, ELISE
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:ROSENTHAL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 UPMINSTER D
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-2839
Mailing Address - Country:US
Mailing Address - Phone:732-309-6656
Mailing Address - Fax:
Practice Address - Street 1:170 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2198
Practice Address - Country:US
Practice Address - Phone:631-208-4460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker